School of Public Health, The University of Queensland, Brisbane, Australia.
Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom.
JAMA Cardiol. 2020 Dec 1;5(12):1410-1418. doi: 10.1001/jamacardio.2020.4105.
Early menarche and early menopause are associated with increased risk of cardiovascular disease (CVD) in midlife, but little is known about the association between reproductive life span and the risk of CVD.
To investigate the association between the length of reproductive life span and risk of incident CVD events, while also considering the timing of menarche and menopause.
DESIGN, SETTING, AND PARTICIPANTS: Individual-level data were pooled from 12 studies participating in the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events consortium. Women provided complete information on the timing of menarche and menopause, nonfatal CVD events, and covariates. Cox proportional hazards models were used to estimate hazard ratios and 95% CIs, adjusted for covariates. The association between reproductive life span and CVD was adjusted for age at menarche and age at menopause separately. Analysis began March 2018 and ended December 2019.
Reproductive life span was calculated by subtracting age at menarche from age at menopause and categorized as younger than 30, 30 to 32, 33 to 35, 36 to 38 (reference group), 39 to 41, 42 to 44, and 45 years or older.
First nonfatal CVD event, including coronary heart disease and stroke events.
A total of 307 855 women were included. Overall, the mean (SD) ages at menarche, menopause, and reproductive life span were 13.0 (1.5) years, 50.2 (4.4) years, and 37.2 (4.6) years, respectively. Pooled analyses showed that women with a very short reproductive life span (<30 years) were at 1.71 (95% CI, 1.58-1.84) times higher risk of incident CVD events than women with a reproductive life span of 36 to 38 years after adjustment for covariates. This association remained unchanged when adjusted for age at menarche but was attenuated to 1.26 (95% CI, 1.09-1.46) when adjusted for age at menopause. There was a significant interaction between reproductive life span and age at menarche associated with CVD risk (P < .001). Women who had both short reproductive life span (<33 years) and early menarche (age ≤11 years) had the highest risk of CVD (hazard ratio, 2.06; 95% CI, 1.76-2.41) compared with those with a reproductive life span of 36 to 38 years and menarche at age 13 years.
Short reproductive life span was associated with an increased risk of nonfatal CVD events in midlife, and the risk was significantly higher for women with early age at menarche.
初潮和绝经早与中年心血管疾病（CVD）风险增加有关，但关于生殖寿命与 CVD 风险之间的关系知之甚少。
研究生殖寿命与新发 CVD 事件风险之间的关联，同时考虑初潮和绝经的时间。
设计、地点和参与者：个体水平的数据来自于参与国际合作的 12 项研究，这些研究采用了生命历程方法研究生殖健康和慢性疾病事件。女性提供了关于初潮和绝经时间、非致命性 CVD 事件和协变量的完整信息。使用 Cox 比例风险模型估计风险比和 95%置信区间，并根据协变量进行调整。生殖寿命与 CVD 的关联分别根据初潮年龄和绝经年龄进行调整。分析于 2018 年 3 月开始，2019 年 12 月结束。
生殖寿命通过从初潮年龄中减去绝经年龄来计算，并分为小于 30 岁、30-32 岁、33-35 岁、36-38 岁（参考组）、39-41 岁、42-44 岁和 45 岁或以上。
首次非致命性 CVD 事件，包括冠心病和中风事件。
共纳入 307855 名女性。总体而言，初潮、绝经和生殖寿命的平均（SD）年龄分别为 13.0（1.5）岁、50.2（4.4）岁和 37.2（4.6）岁。汇总分析显示，与 36-38 岁之间有生殖寿命的女性相比，生殖寿命非常短（<30 岁）的女性发生新发 CVD 事件的风险高 1.71 倍（95%CI，1.58-1.84）。在调整了初潮年龄后，这种关联仍然不变，但在调整了绝经年龄后，这种关联减弱到 1.26（95%CI，1.09-1.46）。生殖寿命和初潮年龄与 CVD 风险之间存在显著的交互作用（P<0.001）。生殖寿命较短（<33 岁）且初潮年龄较早（≤11 岁）的女性与生殖寿命为 36-38 岁且初潮年龄为 13 岁的女性相比，发生 CVD 的风险最高（风险比，2.06；95%CI，1.76-2.41）。
生殖寿命较短与中年非致命性 CVD 事件风险增加有关，而初潮年龄较早的女性风险显著更高。
